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Nursing Interventions

Nursing Interventions

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Published by: paulinian_nurse on Mar 05, 2010
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Nursing Interventions:
1.Encourage mobilization of secretion through ambulation, coughing, and deep breathing.2.Ensure adequate fluid intake to liquefy secretions and prevent dehydration caused byfever and tachypnea.3.Encourage rest, avoidance of bronchial irritant, and a good diet to facilitate recovery.4.Instruct the patient to complete the full course of prescribed antibiotics and explain theeffect of meals on drug absorption.5.Caution the patient on using over-the-counter cough suppressants, antihistamines, anddecongestants, which may cause drying and retention of secretions. However, cough preparations containing the mucolytic guaifenesin may be appropriate.6.Advise the patient that a dry cough may persist after bronchitis because of irritation of airways. Suggest avoiding dry environments and using a humidifier at bedside.Encourage smoking cessation.7.Teach the patient to recognize and immediately report early signs and symptoms of acute bronchitis.
Acute bronchitis
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Acute bronchitis
Classification and external resources
This image shows the consequences of acute bronchitis.
Acute bronchitis
is an inflammationof the large bronchi (medium-sized airways) in the lungs  that is usually caused byviruses or  bacteria and may last several days or weeks.
Characteristicsymptoms includecough,sputum(phlegm) production, and shortness of breath and wheezing related to the obstruction of the inflamed airways. Diagnosis is by clinical examination and
sometimesmicrobiological examination of the phlegm. Treatment for acute bronchitis is typically symptomatic. As viruses cause most cases of acute bronchitis,antibioticsshould not beused unless microscopic examination of Gram stained sputum reveals large numbers of bacteria.
[edit] Cause/etiology
Acute bronchitis can be caused by contagious pathogens. In about half of instances of acute bronchitis a bacterial or viral pathogen is identified. Typical viruses include respiratory syncytialvirus,rhinovirus, influenza, and others.
Damage caused by irritation of the airways leads to inflammation and leads to neutrophilsinfiltrating the lung tissue.
Mucosal hypersecretion is promoted by a substance released byneutrophils.
Further obstruction to the airways is caused by more goblet cells in the small airways.This is typical of chronic bronchitis.
Although infection is not the reason or cause of chronic bronchitis it is seen to aid insustaining the bronchitis.
[edit] Signs and symptoms
Bronchitis may be indicated by anexpectorating cough, shortness of breath (dyspnea) and wheezing. Occasionally chest pains, fever ,and fatigueor malaisemay also occur. Additionally,  bronchitis caused byAdenoviridaemay cause systemic and gastrointestinal symptoms as well.However the coughs due to bronchitis can continue for up to three weeks or more even after allother symptoms have subsided.
[edit] Diagnosis
A physical examinationwill often reveal decreased intensity of breath sounds, wheezing, rhonchi  and prolongedexpiration. Most doctors rely on the presence of a persistent dry or wet cough asevidence of bronchitis.A variety of tests may be performed in patients presenting with cough and shortness of breath:
Achest X-ray that reveals hyperinflation; collapse and consolidation of lung areas would support a diagnosis of  pneumonia. Some conditions that predispose to bronchitis may beindicated by chest radiography.
A sputum sample showingneutrophil granulocytes (inflammatory white blood cells) and culture showing that has pathogenic microorganisms such asStreptococcus spp.
A blood testwould indicate inflammation (as indicated by a raisedwhite blood cellcount and elevatedC-reactive protein).
[edit] Treatment
[edit] Antibiotics
Only about 5-10% of bronchitis cases are caused by a bacterial infection. Most cases of  bronchitis are caused by a viral infection and are "self-limited" and resolve themselves in a fewweeks. Acute bronchitis should not be treated with antibiotics unless microscopic examination of the sputum reveals large numbers of bacteria. Treating non-bacterial illnesses with antibioticsleads to the promotion of antibiotic-resistant bacteria, which increase morbidity and mortality.
[edit] Smoking cessation
For more details on this topic, seeSmoking cessation.Many physicians recommend that to help the bronchial tree heal faster and not make bronchitisworse,smokersshould quit smoking completely to allow their lungs to recover from the layer of tar that builds up over time.
[edit] Antihistamines
Using over-the-counter antihistaminesmay be harmful in the self-treatment of bronchitis.An effect of antihistamines is to thicken mucus secretions. Expelling infected mucus viacoughing can be beneficial in recovering from bronchitis. Expulsion of the mucus may behindered if it is thickened. Antihistamines can help bacteria to persist
and multiply inthe lungs by increasing itsresidence timein a warm, moist environment of thickened mucus.Using antihistamines along with anexpectorant cough syrup may be doubly harmful encouraging the production of mucus and then thickening that which is produced. Using an expectorant coughsyrup alone might be useful in flushing bacteria from the lungs. Using an antihistamine alongwith it works against the intention of using the expectorant.
[edit] Prognosis
Acute bronchitis usually lasts a few days or weeks.
It may accompany or closely follow a coldor the flu, or may occur on its own. Bronchitis usually begins with a dry cough, including wakingthe sufferer at night. After a few days it progresses to a wetter or productive cough, which may be accompanied by fever, fatigue, and headache. The fever, fatigue, and malaise may last only afew days; but the wet cough may last up to several weeks.

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